amp The GP Marijke Boers Church St Surgery April 2017 Role of the G P Is this NORMAL age related memory loss ORSomething Else REFERENCE Having a Senior Moment Best Practice Journal of BPAC NZ WEBSITE ID: 617478
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Slide1
Memory Loss&The GP
Marijke Boers
Church St Surgery
April 2017Slide2
Role of the G. P.Is this NORMAL age related memory loss
OR…..Something Else…..
REFERENCE: Having a Senior Moment ?
Best Practice Journal of BPAC NZ WEBSITE
Number 36, Issue 23Slide3
We All Have Age Related Memory LossStarts in our 20’s
Accelerates from age 50
Neurones Reduce, Brain volume shrinks, synapses less efficient
Names/words/laying down new information
Genetics, hormones, other illness, environmental factors Slide4
4 Types of Memory
Episodic Memory- For significant events
Learning and recall Declines from middle age
Semantic Memory – factual and conceptual knowledge
Volume increases from middle age to young elderly, then declines
Procedural Memory- how to of skills and procedures…
normally retained into late life
Working memory – learning new information, retaining and then manipulating it-
eg
- following a map, new person’s name, learning a new procedure…
with age, the span often becomes shorterSlide5
Mild
Frequently Misplaces Items
Forgets names , slow to recall them
Word finding difficulties
Forget recent events or newly learned information
Temporarily becomes lost, trouble understanding or following a map
Worries about memory loss. Friends and family are noticing
Dementia
Forgets use of an item, or puts in wrong place
Forgets knowing someone
Begins to lose language skills
Loses sense of time, not sure what day it is
Working memory seriously impaired. Difficulty learning or remembering new information
Becomes easily disorientated or lost in familiar places
Little or now awareness of thinking /problem solving difficultiesSlide6
1. Confirm Memory and Thinking Problems Memory Tests
Family Informant Questionnaire
(Helpful to have information from family and loved ones)
Consider repeating, different times, different questionnaires or versions of a questionnaireSlide7
2. Rule out other causes
Infections
Heart or Breathing problems
Nutritional or Hormonal (
eg
Diabetes)
Mood or anxiety problems
…. So , MUST
I
NCLUDE
A physical examinationBlood Tests Slide8
Once Cognitive Impairment ConfirmedAny REVERSIBLE Causes ?- FIX THOSE
Check Safety at home, driving,
etc
See if patient needs support in their home- REFER to ICM or support services
If Mild, attend to diet, lifestyle, stimulation
If moderate, Consider CHOLINE ESTERASE INHIBITOR- or similarSlide9
CHOLINESTERASE INHIBITOR, BPJ Issue 30, P28
Acetyl Choline- important in brain for memory and other functions
Medication MAY be helpful in moderate or advanced
Alzheimers
…. Slows decline or even brief improvement
Does not
prevent
Decline, Sadly
Discuss Pros and Cons, consider side effects (Nausea , slowed heart rate, slow to wee…)
Side effects short lived, dose dependent
Monitor response carefully, get Specialist input , wean off when no longer helpful